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Amlodipne + lisinopril

CARDIOVASCULAR SYSTEM

ANTIANGINAL - [ CARDIOVASCULAR SYSTEM ]

Amlodipine is a dihydropyridine calcium channel blocker that inhibits transmembrane influx of calcium ions into the vascular smooth muscle and cardiac muscle. Lisinopril is an angiotension-converting enzyme inhibitor that reduces BP, mainly by suppressing the renin-angiotensin-aldosterone system. Combination of the two drugs results in additive antihypertensive action. (1,2,3,4)

Mild to moderate hypertension (1,2)

Hypersensitivity to either component, history of angioedema related to ACE inhibitor, patients with hereditary or idiopathic angioedema. Pregnancy & lactation. (1,2,3,4)

Nausea, headache, dizziness, cough, diarrhoea, fatigue, rash, oedema, flushing, palpitation, chest pain, asthenia, dry mouth; elevations in BUN, serum creatinine and potassium may occur. Potentially Fatal: Angioneurotic oedema reported with ACE inhibitors. (1,2,3,4)

There is an increased risk of hypotension with concurrent use of antihypertensives with alprostadil. Amlodipine: Increased risk of hypotension with concurrent use with alprostadil, non-nucleoside reverse trancriptase inhibitors and cytochrome P450 inhibitors such as protease inhibitors (such as ritonovir), quinupristin/dalfopristin, azole antifungals (such as itraconazole and ketoconazole). Reduced effect of amlodipine with cytochrome P450 inducers such as phenobarbital, primidone, rifampicin and St John's Wort. Lisinopril: It reduces potassium loss caused by thiazides. Patients on diuretics may experience increased reduction in BP. Hyperkalaemia with concomitant use of potassium-sparing diuretics/potassium supplements may occur. Lisinopril may increase serum lithium levels; monitoring of serum lithium levels is recommended. Concurrent use with NSAIDs may further worsen renal function in patients with renal impairment; may also reduce the antihypertensive effect of lisinopril. (1,2,3,4)

Dose adjustment is mandatory in renal impairment, hepatic impairment and heart failure. Caution when used in patients with severe obstructive coronary artery disease due to risk of increased frequency, duration and/or severity of angina or acute MI. Safety and efficacy have not been established in children. (1,2,3,4)

Adult: Each tablet contains amlodipine 5 mg and lisinopril 5 mg: Usual initial dose 1 tablet daily. May increase to 2 tablets daily, if BP control is still inadequate after 1-2 wk. (1,2,3,4)

1 Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. China: McGraw Hill; 2011. 2 National Formulary of India. 4 th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011. 3 Amlodipine. [cited on 2nd september]. Available online from website http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019787s054lbl.pdf 4 Lisinoprol. [cited on 2nd september]. Available online from website http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/019777s061lbl.pdf